What is Seasonal Affective Disorder (SAD) and what can we do about it?

What is SAD?

SAD is a problem of recurring episodic depression, characteristically associated with the arrival of the autumn or winter months, but typically relieved with the onset of spring.

Estimates vary, but there is no doubt that SAD is a common problem. Significant winter depressions are thought to occur in three out of every 100 of the population. Twice as many women as men experience SAD and the most common onset ages are in the early 20s and 30s.

Episodes of SAD are typically depressing and they can last many weeks, with a person experiencing many common depressive features, such as a reduction in mood or energy, a loss of joy or concentration, and also a loss of appetite or even over-eating.

Of course, these features may be seen with any depression, but, with SAD, these depressive symptoms arise either new, “out of the blue”, or coincident in addition to other symptoms already being experienced by someone with anxiety or depression. In other words, SAD may be a recurring isolated and discrete problem, or an additional and coexisting one.

What causes SAD?

There is no known cause for SAD, but, as ever with mental health diagnoses, theories about causes are plentiful. These theories are generally psychological and/or social, but, in the case of SAD, the most compelling theories relate to the detrimental influence on the brain of loss of sunlight in our environment.

It seems likely that the reduction in the number of daylight hours has something to do with the onset of SAD. A chemical messenger in the brain called melatonin fluctuates, or changes, with exposure to light. This hormone arises from the hypothalamus and this is an area of the brain known to be associated with the regulation of mood, appetite and energy.

However, fluctuations in melatonin induced by darkness do not entirely explain things. For example, in countries where there is an even greater seasonal reduction of daylight hours (such as in Scandinavia), there is no greater incidence of SAD. To my mind, there has to be more to SAD than melatonin, but as yet we just don't know. The subjective influence of other seasonal stresses is probably also a factor.

Mental health difficulties like SAD are not on the increase. It may simply be that we are more aware of them. Still, overall levels of mental health distress do appear to be increasing in other areas. The trends are worrying. Recent evidence from the United Kingdom (UK) has revealed a near four-fold increase in certain stress-related, common mental health disorders. There has been a substantial increase in post-traumatic stress disorder, particularly in young women, and also a large increase in self-harm and suicidal behaviours.

SAD or seasonal depressive disorders do not not appear to be precipitated by the stresses or traumas of life. SAD is a form of mental suffering that is very challenging. For me, this tells us something important about mental health and wellbeing. There is no single cause of mental health difficulty (just as there is no single definition of mental wellbeing). We are human and so all these things have psychological, biological, social and spiritual aspects to them, and probably lots more besides!

What can I do if I have SAD?

So, what can we do about getting SAD?

Well, as ever, it is always better to start by talking about it. Share the problem. A problem shared is a problem halved, as they say. Nothing is resolved in secret. Of course, the usual advice applies. Talk to a loved one, a family friend, a partner, a family physician, but, most of all, tell someone. These conversations don't have to be about blame, but they can help to explain, and that can give great relief.

Mild degrees of distressing symptoms can also be relieved by taking small practical steps. These include fostering greater self-care, taking more exercise, eating better and seeking out greater sources of positive life-affirming company. In that way, SAD may be like any other mild depression.

More severe cases where symptoms are persistent and pervasive, and where low mood is associated with multiple consequences, such as impaired concentration, loss of weight or suicidal thoughts, may indicate a need for more active treatment.

The melatonin theory has led to the development of light as a therapy. It is possible to buy lights known as “light boxes” that emit constant beams of northern light (that is to say these boxes emit specific wave lengths without potential harmful ultraviolet, or UV, bands). These are available commercially and, for some, they are very helpful. Most of those who benefit do so within a week of using about 30 minutes or so of therapy, usually in the morning and every day. Some manufactures offer a light box for a trial period and it’s wise to take up such an offer before parting with lots of expense. If it’s not going to work for you, it can be returned at no loss.

Other people benefit from Cognitive Behaviour Therapy (CBT). This helps to reframe the SAD experience and helps people to re-engage with the world and the future despite the SAD struggle. Others may require medication and, as with any depressive episode requiring medication, it’s best to discuss this with your doctor and to consider all the benefits and the risks. For SAD, most physicians would start with a medication from the serotonin family. Whatever approach is taken, whether it is a single measure or a combination, it is essential to persist until recovery is achieved and to persist in recovery for as long as it takes to prevent relapse.

How can I manage wellbeing in winter?

Many of us fear the arrival of the winter months. This is understandable, given the return of the long dark evenings and the hazards of floods and inclement weather. Perhaps this year will be different. Let's hope that this year we will all take time to soothe ourselves and to re-build our reserves of wellbeing.

Of course, there is a natural inclination to hibernate at these times, but, this autumn and winter, we might take a wellness approach. We might look beyond ourselves and to each other for wellness. Perhaps this year, we will make winter a season to be collective and to be warm, joining together within our neighbourhoods and families, whatever their size or shape, to enjoy each other's company, in our clubs and our communities, wherever we may be.

So this winter, as we share time with each other, we may be well and remain so. But as we do, let us spare a thought for those of us with less resources, those without a secure home and without sustained companionship, for those whose resilience has been dented by loss of friendship or positive values. Let us speak up for mental wellbeing wherever we can. Remember mental wellbeing is for every one, especially this winter.

Where can I find more information on SAD?

You can find more information on SAD from the Health Service Executive.

The Royal College of Psychiatrists provides helpful notes about SAD.

There is some helpful information to be had at the Seasonal Affective Disorder Association on light boxes.

Background information on the rise of stress-related mental health disorders in the UK is summarised by Professor Sir Simon Wessley in an article in the HuffPost called Behind the scenes are worrying trends for women mental health.